Transfusion-associated graft versus host disease

Objectives To review the epidemiology, pathophysiology, therapeutic and preventive strategies of transfusion associated graft versus host disease (TA-GVHD) and relate the findings to the critically ill child. Design Review article of published medical literature related to TA-GVHD. Data Sources Medline, bibliography search, published national and institutional guidelines. Study Selection Original publications including prospective studies, case reports, case series, laboratory studies, and animal work. Data Extraction Data were extracted manually after we reviewed selected articles and assessed their contribution to knowledge of TA-GVHD. Data Synthesis New and significant historic information from the selected publications relating to incidence, therapy, prevention, and complications of preventive therapy of TA-GVHD was incorporated. Conclusions Pediatric critical care practitioners should be aware of this preventable but fatal complication of cellular blood product transfusion. High-risk categories include congenital and acquired immunodeficiency, younger age, transfusion of blood donated by family members, and transfusion with fresh whole blood. Children at risk for the development of TA-GVHD include neonates, infants, and children with congenital heart disease, not restricted to children with "classic" DiGeorge syndrome. At present, risk identification and targeted prevention are the only methods to manage TA-GVHD. Aside from minimizing cellular blood product exposure, blood product irradiation is the only established and widely available method to prevent TA-GVHD. Transfusion guidelines need to reflect a balance between the incidence of TA-GVHD and the costs of instituting irradiation to selected groups or as routine transfusion policy.